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Alarm features and age for predicting upper gastrointestinal malignancy in Chinese patients with dyspepsia with high background prevalence of Helicobacter pylori infection and upper gastrointestinal malignancy: an endoscopic database review of 102 665 patients from 1996 to 2006
  1. Yu Bai1,
  2. Zhao-Shen Li1,
  3. Duo-Wu Zou2,
  4. Ren-Pei Wu3,
  5. Yin-Zhen Yao3,4,
  6. Zhen-Dong Jin1,
  7. Ping Ye3,
  8. Shu-De Li3,
  9. Wen-Jun Zhang1,
  10. Yi-Qi Du1,
  11. Xian-Bao Zhan1,
  12. Feng Liu1,
  13. Jun Gao1,
  14. Guo-Ming Xu4
  1. 1Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China
  2. 2Center for Clinical Epidemiology & Evidence-Based Medicine, Second Military Medical University, Shanghai, China
  3. 3Digestive Endoscopy Center, Changhai Hospital, Second Military Medical University, Shanghai, China
  4. 4Training Center of the Asia-Pacific Society of Digestive Endoscopy, Changhai Hospital, Shanghai, China
  1. Correspondence to Professor Zhao-Shen Li, Department of Gastroenterology, Changhai Hospital, Second Military Medical University, 168 Changhai Road, Shanghai, China; li.zhaoshen{at}hotmail.com

Abstract

Objective Patients with dyspepsia with alarm features are suspected of having upper gastrointestinal (GI) malignancy; however, the true value of alarm features in predicting an underlying malignancy for patients with dyspepsia with high background prevalence of Helicobacter pylori infection and upper GI malignancy is uncertain. The aim of the present study was to determine the diagnostic accuracy of alarm features in predicting upper GI malignancy by reviewing an endoscopic database consisting of >100 000 Chinese patients.

Methods A retrospective analysis of prospectively collected data was conducted in a single tertiary medical centre. Consecutive patients who underwent oesophagogastroduodenoscopy (OGD) for dyspepsia in 1996–2006 were enrolled. The data including gender, age, symptoms, and endoscopic and pathological findings were analysed. The main outcome measure was the diagnostic accuracy of individual alarm feature.

Results 102 665 patients were included in the final analysis. Among all the 4362 patients with malignancy, 52% (2258/4362) had alarm features. Among 15 235 patients who had alarm features, 2258 (14.8%) were found to have upper GI malignancy. The pooled sensitivity and specificity of the alarm features were 13.4% and 96.6%, respectively. Only the feature of dysphagia in patients between 36 and 74 years old had a positive likelihood ratio (PLR) >10 for malignancy prediction, while all other alarm features in other age groups had a PLR <10.

Conclusions For uninvestigated Chinese patients with dyspepsia with high background prevalence of H pylori infection and upper GI malignancy, alarm features and age, except for dysphagia in patients between 36 and 74 years old, had limited predictive value for a potential malignancy; therefore, prompt endoscopy may be recommended for these patients. However, less invasive, inexpensive screening methods with high diagnostic yield are still needed to reduce unnecessary endoscopy workload.

  • Alarm features
  • dyspepsia
  • endoscopy
  • gastrointestinal tract
  • upper gastrointestinal endoscopy
  • upper gastrointestinal malignancy

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Footnotes

  • Funding YB is partly supported by the ‘Chen Guang’ project supported by the Shanghai Municipal Education Commission and Shanghai Education Development Foundation (Grant no. 2008CG44), and partly supported by the National Natural Science Foundation of China (Grant No. 30801087).

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the Shanghai Changhai Hospital Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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